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Monday, 25 June 2018
Page: 6192


Mr ZAPPIA (Makin) (16:28): I begin by commending the comments of the member for Ballarat and concurring with those comments. As the member for Ballarat quite rightly pointed out, the role of the Australian Institute of Health and Welfare is invaluable in assisting governments and oppositions in preparing their policies and frameworks for health budgets in this country. Indeed, the data is important in that it not only determines progress that is being made with respect to policies that are currently in place but also assists governments and oppositions in assessing expenditure efficiencies and enables governments and opposition to set priorities, to identify emerging issues and to identify social inequalities between communities when it comes to the Health portfolio. And I'm sure that there would be many other matters that would arise from the work of the institute.

Health expenditure in this country for 2015-16, which is the last year for which I've got the breakdown of data, was $170 billion. Of that, $70 billion came from the federal government, $44 billion from the states and territories and some $56 billion from private health insurance and patients. All would agree $170 billion of expenditure is a large chunk of money that the Australian economy pays each year for a particular service or a particular sector. It's important to ensure that that $170 billion is well spent and that we're getting the best value for the dollars that are being put into the health system, and whether we're doing that well enough at the moment is indeed a vexed question.

Could we do better? I suspect in some areas we could. That was a question that the Productivity Commission looked at in a research paper in April 2015, which it published under the title Efficiency in health. I will quote just one part of the commission's paper, because it goes to the heart of the importance of the work being done by the institute. I quote directly from page 73 of the report of the Productivity Commission:

Information is central to an efficient and effective health system. It shines a light on good and bad performance, helps the community and governments to hold health care providers to account, facilitates good patient care, and forms part of the evidence base on health interventions. But transparency has fallen short of its potential in health, either because data do not exist or, more importantly, data are not made available. The United Kingdom, United States and Canada outperform Australia in collecting and releasing data on particular aspects of health service delivery, such as performance data on individual hospitals and administrative data on the use of health services. Better progress in these areas would benefit clinicians, hospital managers, researchers, policy makers and, ultimately, patients and taxpayers.

That quote highlights not only the importance of the work that is being done by the Australian Institute of Health and Welfare but, equally, the shortfalls that we currently have. There is a lot of data within our health system that is either not being collected or not being shared. By it not being shared in particular—I know that some of the data which I refer to is collected—it makes it much more difficult for governments to implement efficient health systems and it makes it much more difficult for us as a nation to try and provide the best health care possible across the country.

Indeed, only last week at a presentation in this parliament with respect to the future value of e-health in this country, the point was very strongly made that the e-health system will enable much more coordination of health services across the country, which, in turn, will lead to efficiencies simply because there is very likely going to be much less duplication of medical services than is currently taking place. Currently, because quite often a doctor or a hospital is not aware of the particular conditions of a patient, they duplicate tests and spend time in providing other health support that perhaps others have already provided. Had the information been available to them through, say, the e-health record system, it would have saved that unnecessary expense. We can and should do better. Again, it's the collection of data that will make that possible.

The question with respect to the Australian Institute of Health and Welfare also raises the question of who is collecting data. Again, the member for Ballarat talked in particular about the Australian Bureau of Statistics and the overlap that now seems to have arisen between the work of the ABS and the Australian Institute of Health and Welfare. Perhaps there is an overlap, but I have no doubt that when an organisation has existed for some 30 years it has some history that goes to not only its credibility but also its development of the most efficient and expert ways of collecting that material. In fact, it would be an absolute shame to see the organisation in any way diminished either by funding cuts or by taking away some of the work that it has been doing over those 30 years. Surely the expertise that has been built up over those years in the department should not be lost, and I would hope it's not. Of course, that's not to say that the institute couldn't be improved. I see this legislation as perhaps a way of improving its work. Again, as the member for Ballarat quite rightly pointed out, the Nous Group conducted a review of the department and, in turn, came back with some 35 recommendations, and this was one of the key ones.

I want to talk for a few moments about the work of the institute and provide some examples of the important work it does. In its latest report to do with the state of health in Australia in 2018, I'll talk about three different areas. The first is the health status of Indigenous people in this country. We know that there are about 787,000 people of Indigenous identity. Two-thirds of them live in regional, rural or remote Australia. whilst I accept that in recent years there have been some improvements with respect to their health status, in particular relating to child mortality, a reduction in smoking rates and an increase in life expectancy, the reality is that there are still many gaps. I will read out some of the gaps that the institute points to in their latest report.

Compared with non Indigenous Australians, Indigenous Australians are 2.9 times as likely to have a long-term ear or hearing problem amongst children, 2.7 times as likely to smoke, 2.7 times as likely to experience high or very high levels of psychological distress, 2.1 times as likely to die before their fifth birthday, 1.9 times as likely to be born with low birth weight, and 1.7 times as likely to have a disability or restrictive long-term health condition. A lot of that is attributed to things like lower education levels, poorer housing quality, unemployment lower income, higher smoking rates and alcohol consumption and poorer access to health services. They all contribute to those statistics. Nevertheless they are statistics that paint a very clear divide between city Australians and country Australians and, in particular, the Indigenous Australians that live out in the country.

The other example I use from the report is in respect of the poorer health outcomes experienced outside of major cities—again, where nearly a third of the population lives; three out of 10 Australians live outside of the major cities. I go to the question of smoking rates. In the major cities, it's 13 per cent; in inner regional areas, it's 18 per cent; and in outer regional and remote areas, it's 22 per cent. In terms of obesity, another issue that is frequently talked about as a measure of our health in this country, in the major cities, 61 per cent of people are either overweight or obese; in inner regional areas, it's 67 per cent; and in remote areas, it's 68 per cent. The last of the statistics I will use is the lifetime risky drinking habits. In the major cities, it's 15 per cent of the population; in inner regional areas, it's 18 per cent; and in outer regional and remote areas, it's up to 24 per cent. Those statistics paint their own picture and tell their own story. As I said, when we talk about people living in outer regional, remote and even inner regional areas, that's also where a lot of our Indigenous people live and in particular where a lot of the people that will be classified as people in the lowest socioeconomic status live. That's the last category I want to turn to with respect to some of the statistics.

Compared with people in the highest socioeconomic group, people in the lowest group are 2.7 times as likely to smoke, 2.6 times as likely to have diabetes, 2.4 times as likely to state cost as a barrier to seeing a dental professional, 2.3 times as likely to state cost as a barrier to filling a prescription and 2.1 times as likely to die of potential avoidable causes. A higher ratio of people living in rural regional and remote Australia fall into the low socioeconomic status. Go away from the big cities and not only are people experiencing worse health effects; they are also in a higher level in the lower income group and the lower socioeconomic group.

It's a major problem. That is the point I'm trying to make very clear with respect to the report and why I alluded to those three passages. The message is absolutely clear: Australians in regional rural and remote parts of the country have much poorer health outcomes than those in the city areas. The latest Australian Institute of Health and Welfare report confirms that. The question is: what are we as a society doing about that, and what is the Turnbull government doing about that? I know that there have been some programs put in place. I accept that and we support most of them. Indeed, we supported in particular the appointment of the Rural Health Commissioner, and I note that his annual report has just been released. But the truth is the government's now been in office for five years, and many of the programs that the government has committed to will not see results for many more years to come as well. So it's a long time waiting for people in country Australia to see a real shift and a real improvement in their health outcomes.

It is that point that I wish to stress to the minister—and I see that the minister is here at the table. We as a parliament, on both sides of parliament, need to do a lot more because, quite frankly, we shouldn't have two classes of Australians when it comes to health outcomes in this country. It has been the case for too long. We know it's been the case for the Indigenous people. Whilst we have a Close the Gap strategy in place and, as I said earlier, we are making some progress, the progress is simply not enough, and it will not be enough until we make greater commitments to funding of the services that those people need.

I get back to the core of this debate, and that is about the Australian Institute of Health and Welfare. The importance of that institute is that it provides us with the statistics that we need in order to make sensible and effective decisions when it comes to health expenditure in this country. With those remarks, I move:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, and while acknowledging the valuable work of the Australian Institute of Health and Welfare, the House condemns the Government for its relentless cuts to Medicare and the impact on the health and welfare of all Australians".

The DEPUTY SPEAKER ( Mr Irons ): Is the amendment seconded?

Mr Husic: I second the amendment and reserve my right to speak.

The DEPUTY SPEAKER: The original question was that this bill be now read a second time. To this the honourable member for Makin has moved as an amendment that all words after 'that' be omitted with a view to substituting other words. If I suits the House, I will state the question in the form 'that the amendment be agreed to'. The question now is that the amendment be agreed to.